Doctors fear loss of patient relationships as government announces GP appointments to be moved to phone or online

‘Being able to put a face to a name is at very heart of primary care,’ DAUK chair says

Matt Hancock has said all initial GP consultations should be virtual unless there is 'compelling' clinical reason otherwise (iStock)

Leading medical associations and doctors have expressed fears over missing problems, people lacking access to technology and losing close patient relationships in remote GP consultations after Matt Hancock said there should be a move away from face-to-face appointments.

The UK health secretary said on Thursday all NHS consultations should become virtual unless there was a “compelling clinical reason” otherwise.

The chair of the Doctors’ Association UK (DAUK) responded by saying the announcement was “certainly not the wonder drug to cure the ills of General Practice”.

“Whilst it may be a convenient way for some patients to fit in appointments around busy schedules,” Dr Rinesh Parmar said, ”remote appointments will almost certainly be a barrier for vulnerable groups such as the elderly and impoverished in society.”

He added: “There are concerns that our GPs may have less of an opportunity to pick up diagnoses usually detected in face-to-face consultations and that the rapport between doctors and their patients may suffer.”

Speaking at the Royal College of Physicians (RCP) on Thursday, Mr Hancock said there had been dramatic changes to how the NHS worked as a result of the coronavirus pandemic and some things must not be allowed to go backwards.

“From now on, all consultations should be teleconsultations unless there’s a compelling clinical reason not to,” the UK health secretary said.

“Of course if there is an emergency, the NHS will be waiting and ready to see you in person just as it always has been. But if they are able to, patients should get in contact first via the web or by calling in advance.”

Dr Sonia Adesara, a GP registrar, told The Independent she did not believe virtual appointments should be the “default”, but an “option” for patients to be used when “appropriate”.

“There is something special about that doctor-patient relationship, which you get from face-to-face consultation,” she said, adding this could be especially important when dealing with people with mental health conditions or long-term illnesses.

“Often someone comes to see you, what they’ve come to see you with is not what you actually end up talking about,” the London doctor told The Independent. “All of that can be lost when you put in that barrier.”

Dr Parmar from DAUK said GPs and patients being able to “put a face to a name is at the very heart of primary care”.

Mr Hancock said on Thursday there had been a move towards virtual GP services during the coronavirus pandemic, saying more than 70 per cent of routine GP consultations were delivered remotely in the four weeks leading up to 12 April.

While practices have been doing more digital and telephone consultations, which aim at stopping the spread of Covid-19 and protecting staff and patients from infection, around one in seven UK appointments in the middle of July were still face to face, according to a survey by the Royal College of GPs.

The College’s chair said the poll discovered many GPs using telephone triage or consultations more often due to coronavirus “have found them an efficient way of delivering care”.

Professor Martin Marshall said this way of interacting with patients could also improve access to those who may find it difficult to come into a GP practice, including those with mental health issues.

However, he said phone consultations ”pose a challenge for GPs, not least the lack of visual cues that we often use to help us make a diagnosis”.

Professor Marshall said the “biggest challenge” was working remotely with patients with “complex health needs”. In this case, he said: “Being in the same room as a patient, with whom you might have built up a relationship over time, is incredibly useful and difficult to replicate remotely.”

“Once more normal service resumes in general practice – and we await official guidance on this – patients who want face to face appointments will be able to have them,” Professor Marshall said. “We want patients to be able to access GP services in the way that is best for them and best meets their health needs.”

Some surgeries had already been running a system where patients get remote consultations first before the pandemic.

Dr Yusuf Rajbee told The Independent his practice has been doing this for around two years, and it has been particularly useful during the coronavirus outbreak.

“It’s allowed us to carry on pretty much business as usual through the pandemic,” the GP from Portland Medical in London, a digital-first GP surgery, told The Independent.

“It’s necessary in terms of future-proofing,” he added.

Dr Rajbee, who works with Doctorlink, a health technology solutions provider, said triaging patients before a face-to-face GP appointment helps provide useful information to people who do not necessarily need to see a clinician for it, but do not know this.

“It’s really made a massive difference in terms of our capacity, he said. “We know it’s improved our clinical care because we can deal with things in a more timely manner [and] we have got the luxury to follow things up.”

However, some groups have raised concerns over people who may lack access to technology or the skills to use it.

Professor Andrew Goddard, president of the RCP, said: “The RCP has been at the forefront of arguing for using technology to transform the way in which services are provided, for the benefit of patients and the environment, but the government and the NHS must make sure that they bring everyone with them on this journey.

“In a recent survey, 50 per cent of our members told us that they didn’t have access to a webcam.”

Dr Adesara, the London GP registrar, said she worried some of her elderly patients in particular would struggle.

“I think a lot of them don’t have access to Internet or not as efficient using it as younger people,” she said.

Responding to Mr Hancock’s comments on Thursday, the British Medical Association (BMA) council chair, Dr Chaand Nagpaul, said the trade union wants “all doctors to have up-to-date IT that allows them to offer online and tele-video appointments where appropriate”.

However, Dr Nagpaul added: “The suggestion that ‘all consultations should be teleconsultations’, with every patient interaction essentially being screened first, is too rigid and likely to create barriers for many, with a detrimental impact on their care.”

The Department of Health and Social Care have been approached for comment.

Additional reporting by Press Association